The Accuracy Of Various Herpes Tests
This table summarizes the overall accuracy of different herpes tests. Please especially pay attention to the most common test, the IgG testâand most importantly to its false positive and false negative rates.
The table has three columns:
- Test accuracy: how accurate is the test in detecting the herpes virus
- False positive: the test detects the presence of herpes, but the person doesnât actually have it
- False negative: the test doesnât detect the presence of herpes, but the person does have it
Please note: the numbers in the table are averages and may vary from case to case based on factors such as when the test is performed , the testing technique, and the herpes viral load.
| Test Type | |||
|---|---|---|---|
| 100% | 0% | Depends on the time of sample collection: usually 25% but may be up to 70% | |
| Blood test | Commercially available IgG test: 94%Washington University test: > 99% | Commercially available IgG test: up to 19%Washington University test*: 0% | Commercially available IgG test: up to 38%Washington University test*: 0% |
* The Washington University test is considered the âgold standardâ blood test. The false-negative and false-positive rates for the commercially available IgG test are based on a comparison to the Western blot results of the Washington University test.
How Can People Test For Herpes
A person can ask for a herpes test at any sexual health clinic or a doctors office. A healthcare professional will either swab a blister or draw a blood sample.
At-home herpes tests often require a blood sample through a finger prick.
Once a person receives their test results, they should contact a doctor to discuss treatment options, if necessary.
What Is The Most Accurate Test For Lyme Disease
Lyme disease is more common than many people think. Figures from the Center for Disease Control suggest that roughly 300,000 Lyme disease cases occur every year in the US.
The numbers are alarming, but it gets worse as finding accurate diagnostic tests can be challenging. Although the disease is treatable, it is nearly impossible to tackle it effectively if it is not diagnosed accurately and early enough.
Late detection can lead to severe health problems such as arthritis, heart blockage, and inability to concentrate, among other problems.
Given the prevalence and seeming elusiveness of the disease, some of the logical questions concerned persons would ask are: what is the most accurate test for Lyme disease? And when should I get checked for Lyme disease? This article will proffer answers to these and many other related questions. But first, a little background would be in order.
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Serologic Testing For Lyme Disease
William G. Finn, MDMedical Director, Warde Medical Laboratory
We frequently receive calls regarding recommendations for Lyme disease testing. Due to recent minor changes to our Lyme disease test menu, we are taking this opportunity to clarify recommended approaches for the serologic evaluation of patients suspected to have Lyme disease.
Lyme disease is the clinical syndrome caused by infection with the bacterial spirochete Borrelia burgdorferi. Infection by B. burgdorferi is transmitted via the North American deer tick . In its initial phase, Lyme disease typically is characterized by a distinct pattern of rash known as erythema migrans .
The incubation period between initial exposure and onset of EM varies considerably, but typically is about one to two weeks. In the acute phase of infection, the rash may be accompanied by systemic symptoms such as fever, joint and muscle pain, generalized weakness or fatigue, and enlarged lymph nodes. If left untreated, Lyme disease may progress beyond the initial localized cutaneous phase into disseminated phases of disease.
| Initial Localized |
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Where Can I Get Tested For Herpes
You can get tested for herpes and other STDs at your doctors office, a community health clinic, the health department, or your local Planned Parenthood health center.
STD testing isnt usually part of your regular checkup or gynecologist exam you have to ask for it. Be honest with your nurse or doctor so they can help you figure out which tests are best for you. Dont be embarrassed: Your doctor is here to help you, not to judge you.
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Determining Duration Of Infection
As described above, limitations include potential slow time to seroconversion to gG-2. In addition staging the disease as being recently acquired cannot be accomplished reliably by serology. Approximately 20% of those reporting first episodes of genital symptoms are not, in fact, newly infected but are presenting with first clinically apparent recurrences., Most gG-2 based tests will register as positive in such cases however, a negative result does not guarantee recent infection nor does a positive result rule out primary or non-primary episodes, especially with highly sensitive tests such as POCkit.
How Is Herpes Treated
Herpes cannot be cured, but it can be managed. Medications are available that can prevent or shorten the duration of herpes outbreaks. There is a medicine that you can take on a daily basis that can help prevent outbreaks and also lower your risk of spreading the virus to others. Talk to your healthcare provider about your options. Antiviral medications such as acyclovir, famciclovir and valacyclovir can suppress outbreaks and shorten the duration of symptoms and active shedding of virus.
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Traditional Lyme Disease Tests Are Not Specific Enough
Lyme disease is caused by the spiral-shaped bacteria Borrelia. There are multiple species and strains of Lyme borreliae . Therefore, tests must be targeted to these multiple species and strains in order to be able to detect them. If a patient is infected with a species or strain of Lyme borreliae that their test cant detect, they will get a false-negative test result and thus risk missing their diagnosis. This can be costly and dangerous.
Many ELISA and Western blot Lyme disease tests are only equipped to detect one strain of one species of Borrelia: Borrelia burgdorferi B31 . This means that those tests are missing infections caused by other strains and/or species of Lyme borreliae.
In one internal study designed to test the validity of the IGeneX ImmunoBlot against traditional Western blot tests, a total of 132 patients were tested by both Lyme Western blots and Lyme IB. 43 patients were seropositive on the ImmunoBlot, and 14 were positive on standard Western blots prepared from a mixture of two species for Bb ss B31 and 297. Thus 29 of the 43 patients tested negative on Western blots i.e., the Western blot totally missed their infections with strains other than Bb ss B31 and 297.
With such limited tests, patients infected with non-B31 species and strains e.g., B. mayonii, B. californiensis, or European species are at risk of receiving false negatives and missing the chance to treat their diseases.
Use Of Type Specific Tests In Paediatric Sera
Only the HSV-1/HSV-2 gG based Premier type specific test combination from Meridian was tested in paediatric populations in FDA clinical trials. The results prompted a warning in the kit against use of the tests for herpes diagnosis in children. Recently we conducted a blinded study between UW WB and Meridian Premier HSV-1 and HSV-2 kits in sera from 97 children ages 114. The Meridian kits had a 54% specificity for HSV-1 and a 47% specificity for HSV-2. The NHANES survey revealed an HSV-2 seroprevalence of 0.25% in children using immunodot enzyme assay. Eis-Hubinger et al found an HSV-2 seroprevalence of 4% among children with the Gull test and 3% with the Cobas test. Paediatric sera accounted for nearly all of the false positive results in this large comparison study. Performance in paediatric sera by the Focus, POCkit, and other commercial tests are not known. Thus, these tests should be used with caution, if at all, in children under 14.
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Australasian Chapter Of Sexual Health Medicine
Recommendations from the Australasian Chapter of Sexual Health Medicine on herpes, chlamydia, candidiasis, ureaplasma & gonorrhoea.The Australasian Chapter of Sexual Health Medicine is a Chapter of the Royal Australasian College of Physicians Adult Internal Medicine Division that connects and represents Sexual Health Medicine Fellows and trainees in Australia and New Zealand.
Is There Anything Else I Should Know
Herpes can make people more susceptible to HIV infection. The skin lesions give other sexually transmitted diseases , including HIV, openings for entering the body. Likewise, it can make HIV-infected individuals more infectious. Infection with HSV can also increase HIV viral load. HSV-2 infection is a significant opportunistic infection in HIV-infected individuals due to immune system deficiencies up to 90% of HIV-infected individuals are co-infected with HSV-2.
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In The Absence Of Answers
Herpes tests arent the only ones with a risk of false positive results. False positives can occur for any test that diagnoses viral infection based on antibodies, i.e., your bodys immune reaction, rather than direct detection of the virus. For similar diagnostics like HIV and hepatitis C testing, protocols automatically call for a second test that directly detects the virus whenever an antibody test comes back positive, said Paul Swenson, laboratory director in the department of public health of King County, Washington. Herpes, however, is a particularly challenging infection to directly test for, because the virus spends most of its time hiding in nerves. Swab tests can sometimes detect the virus during outbreaks, but this isnt an option for people without symptoms. Thus even the Western blot relies on antibodies, and may give indeterminate results to a small number of people.
But two steps of antibody testing are still more reliable than one step todays diagnostics for Lyme disease and syphilis are a two-step antibody testing approach, said Dr. Edward Hook, a medical epidemiologist specializing in STI screening and prevention at the University of Alabama, Birmingham, who questioned why such a standardized two-step approach hasnt taken firm hold for herpes.
The Blood Tests Do Have A Lot Of Value But Here Are The Biggest Issues:
About 50% of the population has type 1 herpes. Type 1 can be genital or oral. If you have never had symptoms and obtain an IgG based type-specific blood test , and the test comes back positive for type 1, we have no way of knowing whether you are infected orally, genitally, or both. The only way we can know which location is infected is by symptoms.
About 30% of negative results for HSV 1 are false negatives. This means if you test negative, you might still have HSV 1.
If you are positive for type 2 and fall within a positive range of 1.1 – 3.5, theres a decent chance this is a false positive. About 50% of positives that fall in this range are in error, with the closer you get to 3.5 the more likely you are positive and the closer to 1.1 the less likely you are positive. There can be false positives above 3.5 as well but theyre less likely. If you do test positive within this low range, the CDC recommends confirmatory testing. The most accurate confirmatory blood test is the Western Blot. The Western Blot is more complicated to obtain and your insurance may not cover it. In addition, many doctors do not know about the high false positive rate within this range so they incorrectly diagnose their patients without getting confirmation. I have worked with a number of patients diagnosed within this range who I encouraged to follow up with the Western Blot and they discovered they were negative.
Blood tests given too early after possible exposure can be false negative.
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What Happens During A Herpes Test
If you have blisters or sores, your doctor or nurse will gently take a sample of fluid from the sores with a swab and test it.
If you dont have any sores, talk with your doctor or nurse about whether a blood test for herpes makes sense for you. But herpes tests aren’t normally recommended unless you do have symptoms.
The idea of getting tested may seem scary, but try to chill out. STD testing is a regular part of being a responsible adult and taking care of your health. And herpes tests are quick and usually painless.
Testing And Diagnosing Coinfections And Related Microbes
There are quite a few microbes spread by blood-sucking insects that have stealth characteristics similar to those of Borrelia burgdorferi some we know about, and others still waiting to be discovered.
They all have stealth characteristics and the ability to infect and thrive inside cells. They are masters of evading the immune system, and can be even harder to diagnose than borrelia. Symptoms profiles are similar to borrelia and related mostly to stimulation of cytokine cascades, not concentrations of microbes. Though they each have slightly different strategies, their motive is the same: complete a lifecycle stage within the host and move on.
The primary known players in chronic Lyme include mycoplasma, bartonella, and chlamydia species. The most well-known species of babesia, anaplasma, ehrlichia, and rickettsia are more apt to cause acute illness and less apt to be associated with chronic illness, but research is discovering lesser known and lesser virulent species of these microbes that are associated with chronic Lyme. Reactivation of herpes-type viruses is common in chronic Lyme.
Though testing is possible for some species of these microbes, when a natural route of recovery is chosen, extensive testing is not necessary and can actually be very misleading.
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Evidence For Benefit And Harms Of Screening For Hsv
We did not identify any eligible studies directly assessing the benefits or harms of serologic screening for HSV-2 compared with no screening. Therefore, we reviewed literature that might establish an indirect chain of evidence from multiple questions that link screening to health outcomes .
We found evidence from two uncontrolled observational studies that detection of unexpected HSV-2 by screening is associated with potential psychosocial harms, including anxiety, worry, and distress from a HSV-2 diagnosis. Our conclusions about the potential harms of screening differ slightly from those of other reviews focused on the harms of HSV-2 serologic testing., This may reflect differences in scope or eligibility criteria . For example, we excluded studies enrolling persons who were seeking care for genital symptoms or concerns about recent exposure to someone with genital herpes., We also excluded studies that enrolled persons with prior symptoms of HSV-2. When an assessment of current and prior symptom status was not reported, we contacted authors to confirm whether prior symptoms were assessed. We also excluded other studies from our evidence review that were included in prior reviews due to methodological shortcomings , such as high attrition and high risk of selection bias.,
Do Not Order Herpes Serology Tests Unless There Is A Clear Clinical Indication
Herpes serology is not an appropriate screening test in asymptomatic patients and does not accurately confirm whether the person is infected or is a transmission risk to others from asymptomatic shedding. Clinicians also need to consider whether test results will influence treatment or outcomes because, if they do not, then testing is a waste of finite health resources and is not indicated. Herpes serology tests only have good sensitivity and specificity in high prevalence populations. However, selective use of herpes serological tests may be justified for particular groups, such as those at high risk for STIs and human immunodeficiency virus infection who are motivated to reduce their sexual risk behaviour HIV-infected patients patients with sexual partners with genital herpes and in cases where a woman appears to have a first episode of herpes simplex virus during pregnancy.
This recommendation is endorsed by The Royal Australian and New Zealand College of Obstetricians and Gynaecologists .
Supporting evidence
In July 2018 the Australasian Chapter of Sexual Health Medicine undertook a review of their Top-5 recommendations. Due to changes in evidence, and physician support, recommendation 5 was replaced. The removed recommendation read: Reconsider the use of nucleic acid amplification testing for gonorrhoea in low-prevalence populations and people who do not belong to a higher risk group.
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Herpes Testing: Types Accuracy Timing And Necessity
In this section, weâll give you information about herpes testing.
Testing is what ultimately establishes or rule out a diagnosis of herpes. All the other weâve talked aboutâwhat you feel, what you see, and your odds of getting itâhelp us with the diagnosis, but theyâve canât establish it or confirm it.
This section will summarize the different types of herpes tests, their accuracy, how theyâre interpreted, and when theyâre necessary. Tables with important statistics will be followed by FAQ answered by âDr. F,â an STD expert.
So, if you want to know all about herpes testing, this chapter is for you!
Best Subscription For Herpes Test: Letsgetchecked
The LetsGetChecked home kits can test for both HSV-1 and HSV-2. This test kit may be best for people who require regular testing as the companys subscription options can offer significant discounts.
| Collection method | |
|---|---|
| nurses available through LetsGetChecked to discuss positive results | |
| Cost | |
| tests for both HSV-1 and HSV-2 | |
| Con | does not accept insurance |
A person receives a collection kit with all the tools they need to collect their samples at home. This includes needles, a prepaid envelope, alcohol swabs, and a tube. The tests come in discreet packaging so that other people will not know what the person has received.
The person also has access to an instruction video on the company website that explains how they should take their test. LetsGetChecked suggests that people take a blood sample before 9 a.m. and return it to the laboratory on the same day.
The company states that it issues the results within 25 days.
Individuals who receive a positive result can contact a nurse through the company, and they may suggest a treatment plan.
LetsGetChecked offers a one-time purchase for $119. Anyone who requires regular testing can purchase a LetsGetChecked subscription and get discounts on its tests. For instance, a 3-monthly subscription will give a person a 30% saving on the cost of the kits.
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